Distinct VDJ-H Gene Usage between Mutated and Unmutated Patients in B-CLL: Implications for Pathogenesis and Correlation with Clinical Outcome.

In B cell chronic lymphocytic leukemia (B-CLL) somatic hypermutation in the immunoglobulin variable heavy chain (IgVH) identifies two distinct prognostic variants with mutated (M) patients having better survival. Ig recombination in this disease demonstrates biased V, D and J gene usage. To determine features of VDJ recombination associated with changes in biologic behavior we sequenced and analyzed the IgH of 356 patients with B-CLL. Of 375 sequences obtained (19 patients express two VH genes), 202 (54%) were unmutated (UM) (